Mock SAQs 2 Flashcards
A 51-year old man present is referred by his GP to an endocrinologist for suspected acromegaly.
What is the most common cause of acromegaly?
GH secreting pituitary tumour
A 51-year old man present is referred by his GP to an endocrinologist for suspected acromegaly.
List three symptoms of acromegaly?
- Excessive sweating
- Decreased libido
- Headaches
- Muscular weakness
- Thickening skin
A 51-year old man present is referred by his GP to an endocrinologist for suspected acromegaly.
What is the diagnostic test for acromegaly?
Glucose tolerance test
A 51-year old man present is referred by his GP to an endocrinologist for suspected acromegaly.
The diagnosis of acromegaly is confirmed. What are the two groups of pharmacological therapies that he could be prescribed?
GH antagonists
Somatostatin analogues
Dopamine agonists
A 51-year old man present is referred by his GP to an endocrinologist for suspected acromegaly.
Name two associated comorbidities of acromegaly?
Hypertension Arthritis Obstructive sleep apnoea Heart diease Impaired glucose tolerance Diabetes
A 48-year old woman present to A&E with a sharp, severe chest pain that is by relieved sitting forwards. The doctor suspects pericarditis.
What are two differential diagnoses for pericarditis?
Acute coronary sydrome Aortic dissection Gastric ulcer Oesophagitis Pancreatitis Pneumonia Pleuritis
A 48-year old woman present to A&E with a sharp, severe chest pain that is by relieved sitting forwards. The doctor suspects pericarditis.
Name an investigations that should be carried out in this patient and it’s results?
ECG
Saddle shaped ST elevation
PR depression
A 48-year old woman present to A&E with a sharp, severe chest pain that is by relieved sitting forwards. The doctor suspects pericarditis.
What drug can be given to reduce the chance of recurrence of pericarditis?
Colchichine
A 48-year old woman present to A&E with a sharp, severe chest pain that is by relieved sitting forwards. The doctor suspects pericarditis.
Three complications of pericarditis?
Pericardial effusion
Cardiac tamponade
Constrictive pericarditis
A 20-year old woman has been recently diagnosed with iron deficiency anaemia.
What type of anaemia is iron deficient anaemia?
Microcytic
A 20-year old woman has been recently diagnosed with iron deficiency anaemia.
What are two causes of iron deficient anaemia?
Poor iron intake
Malabsorption
Increased demands i.e growth and pregnancy
A 20-year old woman has been recently diagnosed with iron deficiency anaemia.
What are three symptoms of anaemia?
Fatigue Lethargy Dyspnoea Palpitation Intermittent claudication
A 20-year old woman has been recently diagnosed with iron deficiency anaemia.
How is iron transported in the blood and how is it stored?
Transported bound to transferrin and stored as ferritin
A 40-year old man is suffering with dyspepsia and epigastric tenderness during and just after eating. His GP suspects a peptic ulcer.
What are 3 causes of peptic ulcers?
NSAIDs
Smoking
Mucosal ischaemia
Increased gastric secretion
A 40-year old man is suffering with dyspepsia and epigastric tenderness during and just after eating. His GP suspects a peptic ulcer.
From his presentation, where do you expect is peptic ulcer to be and why?
Stomach, his epigastric tenderness is during eating/after, intestinal would be a when hungry, duodenal at night
A 40-year old man is suffering with dyspepsia and epigastric tenderness during and just after eating. His GP suspects a peptic ulcer.
What drug group can be used to reduce gastric acid secretion?
Proton pump inhibitors
A 40-year old man is suffering with dyspepsia and epigastric tenderness during and just after eating. His GP suspects a peptic ulcer.
What is a complication of peptic ulceration?
Bleeding
A 22-year old man has gradual onset back and buttock pain that is relieved somewhat on exercise. He is referred to a rheumatologist and ankylosing spondylitis is diagnosed.
What group of inflammatory joint disorders does this fall under?
Spondyloarthropathy
A 22-year old man has gradual onset back and buttock pain that is relieved somewhat on exercise. He is referred to a rheumatologist and ankylosing spondylitis is diagnosed.
What genetic association to these conditions share?
HLA-B27 association
A 22-year old man has gradual onset back and buttock pain that is relieved somewhat on exercise. He is referred to a rheumatologist and ankylosing spondylitis is diagnosed.
Other than the features listed, name two other features of this condition?
Psoriasis Enthesitis Dactylitis Crohns UC Eye involvement
A 22-year old man has gradual onset back and buttock pain that is relieved somewhat on exercise. He is referred to a rheumatologist and ankylosing spondylitis is diagnosed.
What is the first sign on x ray of this condition?
Sacroilitis
A 22-year old man has gradual onset back and buttock pain that is relieved somewhat on exercise. He is referred to a rheumatologist and ankylosing spondylitis is diagnosed.
Name three means of management for this condition?E
Excercise
Phyisotherapy
NSAIDS
TNF-alpha blockers
A woman presents to A+E with acute kidney injury.
What are two different diagnostic criteria for this condition?
Rise in creatinine 1.5x the baseline
<0.5ml/kg/hr for >6 hours §
A woman presents to A+E with acute kidney injury.
What are two risk factors for acute kidney injury?
Old age CKD Cardiac failure PVD Sepsis Poor fluid intake/loss
A woman presents to A+E with acute kidney injury.
Name 2 pre renal and 2 renal causes of acute kidney injury?
Pre: hypotension, hypovoleimia, renal artery stenosis
Renal: Acute tubular necrosis, glomerulonephritis, drugs, vasculitis, autoimmune
A woman presents to A+E with acute kidney injury.
Why might hyperkalaemia occur in AKI?
It causes reduced renal excretion of potassium
A 70 year old man has had a recent diagnosis of parkinsons diesease.
What are two histological findings that you can see in a person with PD?
Lewy bodies
Degeneration of dopaminergic neurons
A 70 year old man has had a recent diagnosis of parkinsons diesease.
What are two characteristic signs in the gait of a person with PD?
Shuffling
Reduced arm swing
Slow to get going
A 70 year old man has had a recent diagnosis of parkinsons diesease.
What are the dopaminergic changes seen in PD?
Reduced dopamine in the substantia nigra
A 70 year old man has had a recent diagnosis of parkinsons diesease.
List 2 pharmacological strategies to manage PD?
L dopa
Dopamine agonists
COMT/MAO-V inhibitors
A 60-year old lady present to her GP with a mark on her nose that she is concerned could be cancer. The GP examines it and describes it as a pearly papule with rolled edges.
What type of cancer is it most likely to be?
Basal cell carcinoma
A 60-year old lady present to her GP with a mark on her nose that she is concerned could be cancer. The GP examines it and describes it as a pearly papule with rolled edges.
What are three risk factors for skin cancer?
UV light
Family history
Pale skin
A 60-year old lady present to her GP with a mark on her nose that she is concerned could be cancer. The GP examines it and describes it as a pearly papule with rolled edges.
What is the first line treatment for any skin cancer?
Surgical excision
A 60-year old lady present to her GP with a mark on her nose that she is concerned could be cancer. The GP examines it and describes it as a pearly papule with rolled edges.
Malignant melanoma is more aggressive than skin cancer, name four features of a melanoma lesion that would point towards its diagnosis?
Pigmented Asymmetrical Border irregularity Colour irregularity Changes over time Diameter >6mm
A 19-year old boy present to his GP with a continuous low mood and sadness and he is concerned he may have depression. The GP agrees and prescribes him some medication that may help, he is booked another consultation for 4-week time.
What are three risk factors for depression?
History Grief Conflict Abuse Life events Illness Medication
A 19-year old boy present to his GP with a continuous low mood and sadness and he is concerned he may have depression. The GP agrees and prescribes him some medication that may help, he is booked another consultation for 4-week time.
How does depression manifest physically - give three examples?
Moving slowly Changes in appetite Constipation Lack of energy Loss of libido Changes to menstrual cycle Disturbed sleep
A 19-year old boy present to his GP with a continuous low mood and sadness and he is concerned he may have depression. The GP agrees and prescribes him some medication that may help, he is booked another consultation for 4-week time.
Name two types of medication that the GP could of prescribed him?
Selective serotonin reuptake inhibitors
Tricyclic antidepressants
Monoamine oxidase inhibitors
A 19-year old boy present to his GP with a continuous low mood and sadness and he is concerned he may have depression. The GP agrees and prescribes him some medication that may help, he is booked another consultation for 4-week time.
What should the GP warn the patient about when prescribing anti-depressants?
You may feel worse in the short term, any suicidal thoughts and he should come back
A 19-year old boy present to his GP with a continuous low mood and sadness and he is concerned he may have depression. The GP agrees and prescribes him some medication that may help, he is booked another consultation for 4-week time.
3 non pharmalogical therapies for depression?
Mindfullness
Depression
CBT
Excercise
10-year old child presents to her GP practice unwell with a one-day history of fever, drowsiness, photophobia and neck stiffness. The doctor suspects meningitis.
What is the most common organism to cause meningitis?
Strepococcus pneumoniae
10-year old child presents to her GP practice unwell with a one-day history of fever, drowsiness, photophobia and neck stiffness. The doctor suspects meningitis.
What could would streptococcus pneumoniae stain with gram stain?
Pink
10-year old child presents to her GP practice unwell with a one-day history of fever, drowsiness, photophobia and neck stiffness. The doctor suspects meningitis.
The GP calls for an ambulance for the child to go to hospital, what else should he do?
Give IM benzylpenicillin
10-year old child presents to her GP practice unwell with a one-day history of fever, drowsiness, photophobia and neck stiffness. The doctor suspects meningitis.
At the hospital a lumbar puncture is carried out, it confirms that the organism is a bacteria, what features from analysis may indicate this?
Cloudy Neutrophils Gram film visible High protein Low glucose
10-year old child presents to her GP practice unwell with a one-day history of fever, drowsiness, photophobia and neck stiffness. The doctor suspects meningitis.
In what case would a lumbar puncture be contraindicated in meningitis?
If septicaemia is indicated i.e. rash
80-year old woman in referred to a urology clinic due to stress incontinence.
What is stress incontinence?
Involuntary emission of urine when pressure in the abdomen increases suddenly
80-year old woman in referred to a urology clinic due to stress incontinence.
What anatomical differences make stress incontinence more likely in women?
Only one sphincter
Shorter urethra
80-year old woman in referred to a urology clinic due to stress incontinence.
What are three other types of incontinence?
Urgency, mixed, continuous and overflow
80-year old woman in referred to a urology clinic due to stress incontinence.
First line of management for stress incontinence?
Pelvic floor exercises
A 54-year-old man goes to see his GP regularly for his annual diabetic
review. The doctor takes his blood pressure which is shown to be
145/93mmHg
List three other risk factors for hypertension?
Family history Lack of physical activity Obesity High salt intake Smoking High alcohol intake
A 54-year-old man goes to see his GP regularly for his annual diabetic
review. The doctor takes his blood pressure which is shown to be
145/93mmHg
What blood pressure should be aimed for someone with diabetes mellitus?
<130/80mmHg
A 54-year-old man goes to see his GP regularly for his annual diabetic
review. The doctor takes his blood pressure which is shown to be
145/93mmHg
List two complications of hypertension?
Retinopathy Heart failure Ischaemic heart disease Renal failure Headache Nausea Impotence
A 54-year-old man goes to see his GP regularly for his annual diabetic
review. The doctor takes his blood pressure which is shown to be
145/93mmHg
What type of medication should be given to treat HTN given an example?
ACEi
Rampril
A 54-year-old man goes to see his GP regularly for his annual diabetic
review. The doctor takes his blood pressure which is shown to be
145/93mmHg
Name a test that could be done to assess potential organ damage from hypertension, name the test and result?
Echo or ECG - LV hypertrophy or past MI
Urine analysis- shows proteinuria to check kidney function
Fundoscopy - asses hypertensive retinopathy
A 25-year-old female comes into A&E unable to breath, in and out of
consciousness. Her family member says she was stung by a bee but
weren’t aware she was allergic to anything. However she does have
eczema and her mother has asthma. The doctors suspect she has
undergone anaphylaxis.
List 2 signs that the doctors would look for to determine if its indeed anaphylaxis
Lowered bP Dyspnoea due to bronchoconstriction Rash Swelling Vomiting
A 25-year-old female comes into A&E unable to breath, in and out of
consciousness. Her family member says she was stung by a bee but
weren’t aware she was allergic to anything. However she does have
eczema and her mother has asthma. The doctors suspect she has
undergone anaphylaxis.
What type of hypersensitivity is anaphylaxis?
Type 1
A 25-year-old female comes into A&E unable to breath, in and out of
consciousness. Her family member says she was stung by a bee but
weren’t aware she was allergic to anything. However she does have
eczema and her mother has asthma. The doctors suspect she has
undergone anaphylaxis.
What immunoglobulin is involved in allergic reactions?
IgE
A 25-year-old female comes into A&E unable to breath, in and out of
consciousness. Her family member says she was stung by a bee but
weren’t aware she was allergic to anything. However she does have
eczema and her mother has asthma. The doctors suspect she has
undergone anaphylaxis.
Briefly expain the mechanism of re exposure in anaphylaxis?
Allergen binds to IgE
Receptor cross linking causes a cascade
Mast cell degranulation of histamine
A 25-year-old female comes into A&E unable to breath, in and out of
consciousness. Her family member says she was stung by a bee but
weren’t aware she was allergic to anything. However she does have
eczema and her mother has asthma. The doctors suspect she has
undergone anaphylaxis.
What dosage route and drug would be given?
300mg
IM
Adrenaline
50-year-old man comes into his GP. The patient complaints of Lower
urinary tract symptoms. The doctor performs a digital rectal exam and
finds his prostate to be smooth and enlarged; he suspects benign prostatic
hyperplasia.
What is the pathophysiology of BPH?
Benign nodular or diffuse proliferation
Of muculofibrous and glandular layers of prostate
Inner /transitional zone enlarges
50-year-old man comes into his GP. The patient complaints of Lower
urinary tract symptoms. The doctor performs a digital rectal exam and
finds his prostate to be smooth and enlarged; he suspects benign prostatic
hyperplasia.
Name on storage and one voiding LUTS?
Storage: Frequency, urgency, nocturia
Voiding: Stream poor, Hesitancy, Incomplete emptying, Post micturition dribble
50-year-old man comes into his GP. The patient complaints of Lower
urinary tract symptoms. The doctor performs a digital rectal exam and
finds his prostate to be smooth and enlarged; he suspects benign prostatic
hyperplasia.
List three differentials of LUTS?
UTI
Porstatis
Prostate cancer MS
Diuretic medication
50-year-old man comes into his GP. The patient complaints of Lower
urinary tract symptoms. The doctor performs a digital rectal exam and
finds his prostate to be smooth and enlarged; he suspects benign prostatic
hyperplasia.
Name an investigation that could be done to differentiate from malignancy?
Prostate specific antigen - shouldn’t be too high however can be raised if BPH large
Transrectal ultrasound and biopsy - histology of biopsy
A 4-year-old girl has been brought in, to see the GP, by her mother. On
examination there are itchy, erythematous and scaly patches on her skin.
These are locates on her cheeks and in the flexure of her elbows. Her skin
in general is seen to be quite dry. The mother explains how they
themselves have asthma and that their child has been recently diagnosed
with asthma too.
What is the most likely diagnosis of this child’s complaint|?
Atopic eczema
A 4-year-old girl has been brought in, to see the GP, by her mother. On
examination there are itchy, erythematous and scaly patches on her skin.
These are locates on her cheeks and in the flexure of her elbows. Her skin
in general is seen to be quite dry. The mother explains how they
themselves have asthma and that their child has been recently diagnosed
with asthma too.
|n acute lesions, Staph auerus common, name a test an result to confirm this?
Gram - positive
Coagulase - positive
A 4-year-old girl has been brought in, to see the GP, by her mother. On
examination there are itchy, erythematous and scaly patches on her skin.
These are locates on her cheeks and in the flexure of her elbows. Her skin
in general is seen to be quite dry. The mother explains how they
themselves have asthma and that their child has been recently diagnosed
with asthma too.
Describe the cause of eczema?
Loss of natural moisturising factors causes cracks in the skin
Abnormal lipid bilayer provides inaqudate permeability barrier
A 4-year-old girl has been brought in, to see the GP, by her mother. On
examination there are itchy, erythematous and scaly patches on her skin.
These are locates on her cheeks and in the flexure of her elbows. Her skin
in general is seen to be quite dry. The mother explains how they
themselves have asthma and that their child has been recently diagnosed
with asthma too.
How does emollient therapy help eczema?
Emmollients - artificial restoration of barrier in skin by trapping moisture in the skin
Artificial permeability is formed about stratum corneum
Prevents water loss between corenocytes
A 4-year-old girl has been brought in, to see the GP, by her mother. On
examination there are itchy, erythematous and scaly patches on her skin.
These are locates on her cheeks and in the flexure of her elbows. Her skin
in general is seen to be quite dry. The mother explains how they
themselves have asthma and that their child has been recently diagnosed
with asthma too.
Name a mild treatment for atopic eczema?
Corticosterioids
Hydrocortisone
A 14 year old female has come into A&E with a fever, severe abdominal
pain and vomiting. On examination the pain is seen to be at McBurney’s
point, the doctors suspect appendicitis. This is confirmed after a CT.
Give the definition of appendicitis?
Inflammation of the appendix
A 14 year old female has come into A&E with a fever, severe abdominal
pain and vomiting. On examination the pain is seen to be at McBurney’s
point, the doctors suspect appendicitis. This is confirmed after a CT.
What two results may be shown in a blood test that can help confirm the diagnosis of appendicitis?
Raised white cell count
Raised CRP
A 14 year old female has come into A&E with a fever, severe abdominal
pain and vomiting. On examination the pain is seen to be at McBurney’s
point, the doctors suspect appendicitis. This is confirmed after a CT.
OTher than fever, abdo pain and vomitting, list three other signs of appendicitis?
Anorexia Nausea Guarding Constipation Tachycardia Rebound tenderness Pain on movement
A 14 year old female has come into A&E with a fever, severe abdominal
pain and vomiting. On examination the pain is seen to be at McBurney’s
point, the doctors suspect appendicitis. This is confirmed after a CT.
List three differential diagnoses of appendicitis?
Ectopic pregnancy UTI Cystitis Cholecystitis Diverticulitis Perforated ucler
A 14 year old female has come into A&E with a fever, severe abdominal
pain and vomiting. On examination the pain is seen to be at McBurney’s
point, the doctors suspect appendicitis. This is confirmed after a CT.
Treatment for appendicitis?
Appendicectomy
A father brings in his 5-year-old son into A&E. The boy has been irritable,
getting progressively drowsy and shown signs of photophobia. On
examination the doctor notices a non-blanching petechial and purpuric
skin rash.
What is the triad of presentation in bacterial meningitis?
Headache
Neck stiffness
Fever
A father brings in his 5-year-old son into A&E. The boy has been irritable,
getting progressively drowsy and shown signs of photophobia. On
examination the doctor notices a non-blanching petechial and purpuric
skin rash.
List two common causes of bacterial meningitis in children?
Nessieria meningits
Streptococcus pneumoniae
Haemophilius influenza
A father brings in his 5-year-old son into A&E. The boy has been irritable,
getting progressively drowsy and shown signs of photophobia. On
examination the doctor notices a non-blanching petechial and purpuric
skin rash.
List 2 results you would expect to see in the CSF findings of someone with bacterial meningitis?
CSF is turbid colour
Neutrophils/poylmorphs
Raised protein
Low glucose
A father brings in his 5-year-old son into A&E. The boy has been irritable,
getting progressively drowsy and shown signs of photophobia. On
examination the doctor notices a non-blanching petechial and purpuric
skin rash.
How to differentiate from a sub arachnoid haemorrhage?
SAH headache is far more sudden and severe
A father brings in his 5-year-old son into A&E. The boy has been irritable,
getting progressively drowsy and shown signs of photophobia. On
examination the doctor notices a non-blanching petechial and purpuric
skin rash.
How would you manage someone with a suspected meningococcal septicaemia?
Immediate IV cefotaxime
Do not perform lumbar puncture due to risk of raised ICP
Confirm diagnosis with blood cultures instead
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
What would a T score of -2.3 give?
Osteopenia
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
What is the minimum for osteoporsis?
-2.5
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
What does DEXA stand for?
Duel energy xray absorptiometry
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
What is the first line treatment for osteoporosis?
Bisphosphonates
E.g. alendronate
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
HRT is also a good choice of treatment for this women. How does menopause cause osteoporosis?
Post menopause means lower estrogen levels
increased number of osteoclasts / premature arrest of osteoblastic activity
High bone turnover
A 64-year-old woman is taken to A&E after a fall in her home. After an X-
ray it is clear she has a fracture of her proximal femur. Due to her age and having undergone menopause the doctors complete a DEXA scan, which provided a score of -2.3
What test could differentiate between osteoporosis from osteomalacia?
Blood test
Ca2+ / phosphate is normal in osteoporosis
Low Ca+ / phosphate in osteomalacia
A 6 year old boy is taken into A&E. He is dehydrated, drowsy and
vomiting. He has Kussmaul breathing and his breath has a distinct pear
drop smell. The doctors suspect he has ketoacidosis.
What is the triad of ketoacidosis?
Hyperglycaemia
Ketonaemia
Acidaemia
A 6 year old boy is taken into A&E. He is dehydrated, drowsy and
vomiting. He has Kussmaul breathing and his breath has a distinct pear
drop smell. The doctors suspect he has ketoacidosis.
What blood test could be done to diagnose ketoacidosis?
Blood pH - acidaemia <7.3
Blood glucose >11mmol/L
Ketones >3mmol?l
A 6 year old boy is taken into A&E. He is dehydrated, drowsy and
vomiting. He has Kussmaul breathing and his breath has a distinct pear
drop smell. The doctors suspect he has ketoacidosis.
Describe how ketoacidosis occurs?
In absence of insulin
Unrestrained increase in hepatic gluconeogenesis / peripheral uptake by tissues is decreased
Ketones produced as bodies require glucose in cells / ketone bodies accumulate
A 6 year old boy is taken into A&E. He is dehydrated, drowsy and
vomiting. He has Kussmaul breathing and his breath has a distinct pear
drop smell. The doctors suspect he has ketoacidosis.
What would the HbA1c levels of someone with suspected diabetes be?
> 46mmol
A 19-year-old male has come back from a year abroad, mainly around
Africa. He has gone to see his GP due to feeling feverish, nauseous and
having diarrhoea. He told the GP he thinks he has the flu but the GP
believes there is a chance it is malaria.
What microorganism causes complicated malaria?
Plasmodium falciparum
A 19-year-old male has come back from a year abroad, mainly around
Africa. He has gone to see his GP due to feeling feverish, nauseous and
having diarrhoea. He told the GP he thinks he has the flu but the GP
believes there is a chance it is malaria.
Name a test that could confirm this diagnoses what would it detect?
Thick and thin film
Thick = presence of malaria
Thin - type of plasmodium
Rapid diagnostic test - detects plasmodium antigens in the blood
A 19-year-old male has come back from a year abroad, mainly around
Africa. He has gone to see his GP due to feeling feverish, nauseous and
having diarrhoea. He told the GP he thinks he has the flu but the GP
believes there is a chance it is malaria.
List 2 symptoms of complicated malaria?
Shock
Cerebral malaria
Kidney failure
Acute respiratory distress syndrome
A 19-year-old male has come back from a year abroad, mainly around
Africa. He has gone to see his GP due to feeling feverish, nauseous and
having diarrhoea. He told the GP he thinks he has the flu but the GP
believes there is a chance it is malaria.
List the three stages of malaria infection?
Exo-erythrocytic stage
Endo-erythrocytic stage
Hypnozoite stage
A 38-year-old woman comes into A&E presenting with delirium tremens
and Wernicke’s encephalopathy. She has also been vomiting and is
tachycardic. On examination, the liver feels enlarged.
What is a likely cause of the patients enlarged liver?
Alcoholic liver disease
Alcoholic fatty liver
Alcoholic hepatitis
Alcoholic cirrhosis
A 38-year-old woman comes into A&E presenting with delirium tremens
and Wernicke’s encephalopathy. She has also been vomiting and is
tachycardic. On examination, the liver feels enlarged.
Name a blood test you could do to confirm diagnosis? and result of the test?
Liver function test: AST:ALT >2 / raised GGT
FBC - raised WCC / macrocytic anaemia
Coagulation - increased PTT
A 38-year-old woman comes into A&E presenting with delirium tremens
and Wernicke’s encephalopathy. She has also been vomiting and is
tachycardic. On examination, the liver feels enlarged.
How would you treat delirium tremors?
Chlordiazepoxide
Lorazepam
A 38-year-old woman comes into A&E presenting with delirium tremens
and Wernicke’s encephalopathy. She has also been vomiting and is
tachycardic. On examination, the liver feels enlarged.
Name two causes of Wernickes encephalopathy?
Chronic alcoholism
Eating disorders
Malnutrition
Prolonged vomitting
A 38-year-old woman comes into A&E presenting with delirium tremens
and Wernicke’s encephalopathy. She has also been vomiting and is
tachycardic. On examination, the liver feels enlarged.
What is the triad of Wernicke’s encephalopathy?
Confusion
Ataxia
Opthalmoplegia
A 56-year-old female is at her GP for her annual diabetes check. She has
type 2 diabetes mellitus, which isn’t very well managed and has remained
at a BMI of 32 and her BP was measured at 143/90. She has complained
of feeling breathless, urinating often, especially at night and her legs
feeling swollen. On examination the doctor can see clearly oedema in her
legs and hear crackles in her lungs when breathing. A&E blood test is
performed and the doctor believes she has chronic kidney disease.
What result of the U&E could show it was CKD?
Creatinine
Glucose
Low calcium
High phosphate
A 56-year-old female is at her GP for her annual diabetes check. She has
type 2 diabetes mellitus, which isn’t very well managed and has remained
at a BMI of 32 and her BP was measured at 143/90. She has complained
of feeling breathless, urinating often, especially at night and her legs
feeling swollen. On examination the doctor can see clearly oedema in her
legs and hear crackles in her lungs when breathing. A&E blood test is
performed and the doctor believes she has chronic kidney disease.
What other test could be done to help confirm this diagnosis?
Ultrasound kidneys, ureter = abnormal anatomical/ obstruction
CT kidney / bladder = detect stones, retroperitoneal fibrosis / urinary obstruction
Renal biopsy - nephrotic syndrome
Urine dipstick - high albumin / glucose
A 56-year-old female is at her GP for her annual diabetes check. She has
type 2 diabetes mellitus, which isn’t very well managed and has remained
at a BMI of 32 and her BP was measured at 143/90. She has complained
of feeling breathless, urinating often, especially at night and her legs
feeling swollen. On examination the doctor can see clearly oedema in her
legs and hear crackles in her lungs when breathing. A&E blood test is
performed and the doctor believes she has chronic kidney disease.
Her GFR is measure to be 46 giving her a G3a CKD, what GFR is needed for kidney failure?
<15
A 56-year-old female is at her GP for her annual diabetes check. She has
type 2 diabetes mellitus, which isn’t very well managed and has remained
at a BMI of 32 and her BP was measured at 143/90. She has complained
of feeling breathless, urinating often, especially at night and her legs
feeling swollen. On examination the doctor can see clearly oedema in her
legs and hear crackles in her lungs when breathing. A&E blood test is
performed and the doctor believes she has chronic kidney disease.
Diabetse is a systemic cause of CKD, name three others?
Amyloidosis
Drugs/toxins
Heart failure
Organ rejection
A 56-year-old female is at her GP for her annual diabetes check. She has
type 2 diabetes mellitus, which isn’t very well managed and has remained
at a BMI of 32 and her BP was measured at 143/90. She has complained
of feeling breathless, urinating often, especially at night and her legs
feeling swollen. On examination the doctor can see clearly oedema in her
legs and hear crackles in her lungs when breathing. A&E blood test is
performed and the doctor believes she has chronic kidney disease.
Describe the pathogenesis of CKD?
Scarred nephrons fail
Burden of filtration falls to remaining health nephrons / hyperfiltration / glomerular hypertrophy occurs
Increased glomerular capillary pressure and strain cause damage to remaining nephrons
A 19-year-old Northern European man presents to the hospital with nausea and
vomiting. On further examination, the doctor discovers the man has been having an
increasing need to urinate, unexplained weight loss and feels frequently dehydrated.
The doctor suspects diabetes mellitus
The doctor undergoes a random plasma glucose test - what is the range of values to to indicate diabetes mellitus?
> 11.1 mmol/L
A 19-year-old Northern European man presents to the hospital with nausea and
vomiting. On further examination, the doctor discovers the man has been having an
increasing need to urinate, unexplained weight loss and feels frequently dehydrated.
The doctor suspects diabetes mellitus
Give two examples of other investigations that could be done to confirm the diagnosis?
Fasting plasma glucose >7mmol/L
HbA1c >6.5% from normal
A 19-year-old Northern European man presents to the hospital with nausea and
vomiting. On further examination, the doctor discovers the man has been having an
increasing need to urinate, unexplained weight loss and feels frequently dehydrated.
The doctor suspects diabetes mellitus
Give 2 macrovascular and 2 microvascular complications?
macro = htn,MI, diabetic foot
micro = nephropathy, retinopathy, perirpheral neuropathy
A 19-year-old Northern European man presents to the hospital with nausea and
vomiting. On further examination, the doctor discovers the man has been having an
increasing need to urinate, unexplained weight loss and feels frequently dehydrated.
The doctor suspects diabetes mellitus
GLUT2 receptors found on the surface of insulin releasing cells usually have a low affinity for glucose, why?
Glucose is only detected at higher concentrations and thus insulin is only released when blood glucose is high
A 19-year-old Northern European man presents to the hospital with nausea and
vomiting. On further examination, the doctor discovers the man has been having an
increasing need to urinate, unexplained weight loss and feels frequently dehydrated.
The doctor suspects diabetes mellitus
Give 2 side effects of insulin therapy?
Weight gain
Hypoglycaemia
Localised lipoatrophy
Hypokalaemia
A 60 year old man reports chest pain that woke him from his sleep. He thinks the
pain lasted around 20 minutes and felt sweaty during the pain. He did not want to
bother anyone so he rested and the pain eased. He says it was painful and thus
wants to be checked. He is currently not in pain, but feels tired.
Give three differentials for stable angina chest pain?
Pericarditis PE Chest infection Dissection of aorta GORD
A 60 year old man reports chest pain that woke him from his sleep. He thinks the
pain lasted around 20 minutes and felt sweaty during the pain. He did not want to
bother anyone so he rested and the pain eased. He says it was painful and thus
wants to be checked. He is currently not in pain, but feels tired.
ECG of stable angina?
Usually normal
May show ST depression
A 60 year old man reports chest pain that woke him from his sleep. He thinks the
pain lasted around 20 minutes and felt sweaty during the pain. He did not want to
bother anyone so he rested and the pain eased. He says it was painful and thus
wants to be checked. He is currently not in pain, but feels tired.
Give examples of tests other than ECG that can assess for stable angina?
Coronary angiography
Blood tests
Functional imaging
A 60 year old man reports chest pain that woke him from his sleep. He thinks the
pain lasted around 20 minutes and felt sweaty during the pain. He did not want to
bother anyone so he rested and the pain eased. He says it was painful and thus
wants to be checked. He is currently not in pain, but feels tired.
Give a conservative, medical and surgical option for treatment of stable angina?
Conservative = smoking cessation, weight loss, exercise
Medical = GTN, aspirin
Surgical = CABG, PTCA
20 year old male is suspected to have a Hodgkin’s Lymphoma.
Give 2 examples of risk factors of Hodgkins lymphoma?
An affected sibling
Epstein barr virus infection
SLE
20 year old male is suspected to have a Hodgkin’s Lymphoma.
Give one symptom and one sign of HL?
Symptom = weigh loss, lethargy
Sign = Cachexia, anaemia
20 year old male is suspected to have a Hodgkin’s Lymphoma.
What staging system can be used to determine treatment and prognosis?
Ann arbor system
20 year old male is suspected to have a Hodgkin’s Lymphoma.
What is the most common subtype of hodgkins lymphoma?
Nodular sclerosing
20 year old male is suspected to have a Hodgkin’s Lymphoma.
Which subtype of Hodgkins lymphoma has the worst prognosis?
Lymphocyte depleted
20 year old male is suspected to have a Hodgkin’s Lymphoma.
Patient is treated by radiotherapy and AVDB regimen, name the drugs?
Adriamycin Bleomycin Vinblastine Dacarbazine
40 year old female presents with abdominal pain that radiates to the back that she has had for some time. The pain is recurrent and made worse by eating or drinking heavily, but relieved by sitting forward. She does not smoke and drinks around 20 units per week.
Doctor suspects pancreatitis.
Give three examples of what can cause chronic pancreatitis?
Alcohol Smoking Autoimmunity Pancreatic duct obstruction Cystic fibrosis
40 year old female presents with abdominal pain that radiates to the back that she has had for some time. The pain is recurrent and made worse by eating or drinking heavily, but relieved by sitting forward. She does not smoke and drinks around 20 units per week.
Doctor suspects pancreatitis.
What tests can be done to confirm chronic pancreatitis?
Ultrasound or CT scan of the abdomen
Magnetic Resonance Cholangiopancreatography (MRCP)
Abdominal x ray shows speckled calcificaiton
40 year old female presents with abdominal pain that radiates to the back that she has had for some time. The pain is recurrent and made worse by eating or drinking heavily, but relieved by sitting forward. She does not smoke and drinks around 20 units per week.
Doctor suspects pancreatitis.
State a conservative and medical treatment option for this patient?
Conservative: alcohol cessation, low fat diet
Medical: analgesia e.g. tramadol, pancreatic enzyme replacement therapy, insulin if DM
40 year old female presents with abdominal pain that radiates to the back that she has had for some time. The pain is recurrent and made worse by eating or drinking heavily, but relieved by sitting forward. She does not smoke and drinks around 20 units per week.
Doctor suspects pancreatitis.
State 2 potential complications of chronic pancreatitis?
Pseudocyst Diabetes meillutus Billary obstruction Local arterial aneurysm Gastric varicies
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
Name three other types of seronegative spondyloaropathies?
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
What parts of the skeletal system are inflamed in ankylosing spondylitis?
Spine
Ribcage
Sacroiliac joints
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
What antigen is strongly associated with all seronegative spondyloaropathies?
HLA B27
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
State 1 radiological investigation that can be used to test for ankylosing spondylitis?
MRI scan, X ray of the spine
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
Vertebral syndesmophytes are characterisic of ankylosing spondylitis, what are verebrel syndesmophytes?
Bony proliferations due to enthesitis between ligaments and vertebrae
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
State two medical treatment options for this patient?
TNF alpha inhibitors
NSAIDS
DMARD
Consider bisphosphonates
21 year old male presents with increasing pain and prolonged morning stiffness in the lower back and buttocks. He smokes a pack/day and finds his symptoms improve with exercise. He presents to the doctor with a question mark posture and has a bamboo spine. The doctor suspects him to have ankylosing spondylitis.
Give an exmample of something that would indicate a worse prognosis for this patient?
ESR >30
Onset >16 years
Early hip involvement
Poor response to nsaids
A 30 year old female is suspected to have a acute kidney injury (AKI).
Give an example of a pre renal, renal and post renal cause of AKI?
Pre renal = hypovolaemia(haemorrhage/burns), shock (sepsis)
Renal = glomerular disease(vasculitis, glomerulonephritis, SLE) tubulointestinal disease (acute tubular necrosis)
Post renal = obstruction of the ureter (stones, tumour), obstruction of the bladder neck
A 30 year old female is suspected to have a acute kidney injury (AKI).
What is the most common cause of AKI?
Sepsis
A 30 year old female is suspected to have a acute kidney injury (AKI).
Urinanalysis investigation is used to test for an AKI. Name 2 substances that you would look for in urine to suggest the presence of AKI?
Blood Protein Glucose Leucocytes Nitrates Bence jones protein
A 30 year old female is suspected to have a acute kidney injury (AKI).
How would creatinine change if there was an AKI?
> 26 micromol/L in 48 hours
Rise in creatinine 1.5x baseline within 7 days
A 30 year old female is suspected to have a acute kidney injury (AKI).
What urine output would be diagnostic of AKI?
<0.5ml/kg/hr for >6 consecutuve hours
A 30 year old female is suspected to have a acute kidney injury (AKI).
Hyperkalaemia is a medical emergency and a potential complication of AKI, what two drugs comprise the first line medical management of this emergency?
Insulin and dextrose
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
What 2 clinical patterns of MND could this be?
Amyotrophic lateral sclerosis
Progressive bulbar palsy
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
Define weakness?
Impaired ability to move a body part in response to will
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
Give an example of a UMN sign and an LMN sign other than weakness?
UMN= spasticity, brisk reflexes, upturned plantars
LMN = muscle wasting, fasciculations of the tongue/abdomen
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
How can MND be distinguished from multiple sclerosis and polyneuropathies?
No sensory loss of sphincter disturbance in MND
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
How can MND be distinguished from myasthenia gravis?
MND never affects eye movements
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
Name an investigation that can help diagnose MND other than clinical diagnosis?
Brain / spinal cord MRI
Lumbar puncture
Nerve conduction studies
A 60 year old female is suspected to have motor neurone disease, she is found to have a pattern of UMN and LMN signs
What is the only medication shown to improve the survival of patients suffering from MND and hoe does it work?
Riluzole
Inhibitor of glutamate release and NMDA receptor antagonist
A 25 year old male presents with a fever, rash and headache. Doctor suspects a HIV infection.
Give two differential diagnoses of a fever?
Pneumonia
Meningitis
Encephalitis
TB
A 25 year old male presents with a fever, rash and headache. Doctor suspects a HIV infection.
Name 2 genes of the HIV genome and their function?
Pol - encordes reverse transcription
Eny - encodes the envelope proteins
Nef - increases infectivity
Tat - enhances the production of host transcription
Gag - encodes structural proteins
A 25 year old male presents with a fever, rash and headache. Doctor suspects a HIV infection.
Give an example of an opportunistic infection from HIV?
Toxoplasma gondii
Pneumocystitis jiroveci
Candidias
Cryptosporidium
A 25 year old male presents with a fever, rash and headache. Doctor suspects a HIV infection.
What cells to HIV antigens bind to and enter?
CD4+ lymphocyte
A 25 year old male presents with a fever, rash and headache. Doctor suspects a HIV infection.
Part of the HIV replication processes involves the reverse transcriptase enzyme, name a drug that inhibits it?
Zidovudine (NRTI)
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
Define carcinoma?
Malignant tumour of epithelial cells
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
What is the most common type of carcinoma found in CRC?
Adenocarcinoma
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
State 2 possible symptoms or signs of CRC?
Abdo pain
Unintentional weight loss
Altered bowl habit
Faecal occult blood
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
What is the current bowl cancer screening program?
Faecal occult blood test in men and women aged 60-69
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
What two method can be used to stage CRC?
Duke’s staging system
TMN system
A 70 year old male is suspected to have colorectal cancer. He is smoking 10 cigarettes a day, has IBD and a possible history of CRC.
Patient is diagnose d with CRC, give an example of a conservative, medical and surgical treatment option?
Conservative - referral to MacMillan nurses, patient education, smoking cessation
Medical, radiotherapy, chemoptherapy
Surgical - surgical resection of bowel
40 year old female is feeling tearful, hopeless, anxious, and a continuous low mood for the last 4 weeks. She also states its affecting her work and feels shes taking part in increasingly less social activities. Doctor feels this patient is suffering from depression.
Give 2 examples of physical symptoms that could be associated with depression?
Unexplained aches or pains
Disturbed sleep
Changes to menstrual cycle
Disturbed sleep
40 year old female is feeling tearful, hopeless, anxious, and a continuous low mood for the last 4 weeks. She also states its affecting her work and feels shes taking part in increasingly less social activities. Doctor feels this patient is suffering from depression.
What is the only antidepressant that can be described to under 18 year olds?
SSRI - fluoxetine
40 year old female is feeling tearful, hopeless, anxious, and a continuous low mood for the last 4 weeks. She also states its affecting her work and feels shes taking part in increasingly less social activities. Doctor feels this patient is suffering from depression.
Minimum length of time you should experience depression symptoms for before seeking help?
Every day for 2 weeks
40 year old female is feeling tearful, hopeless, anxious, and a continuous low mood for the last 4 weeks. She also states its affecting her work and feels shes taking part in increasingly less social activities. Doctor feels this patient is suffering from depression.
Give an example of withdrawl symptom of antidepressant medication?
Upset stomach
Flu like symptoms
Anxiety
Dizziness
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
What is atopy?
Individuals who rapidly develop IgE against common environmental antigens
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
State 2 differential diagnoses of asthma?
Pulmonary oedema COPD Large airway obstruciton Pneumothorax PE SVC obstruction
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
State two signs of asthma?
Tachypnoea
Audible wheeze
Hyper inflated chest
Hyper resonant percussion note
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
What is the initial investigation of suspected asthma in an adult after clinical investigation?
Spirometry or peak expiratory flow
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
What range of values for FEV1/FVC ratio mean the patient has airways obstruction?
FEV1/FVC below 0.7
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
Patient find his symptoms decrease on a weekend when his isnt working.
How could you confirm suspicions of his job being a trigger for his asthma?
Ask the patient to measure their peak flow intervals at home and at work at the same time of day to confirm this
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
Patient find his symptoms decrease on a weekend when his isnt working.
State some precipitants of asthma symptoms other than flour?
Cold air Exercise Allergens Infection Smoking Pollution NSAIDS beta blokers
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
Patient find his symptoms decrease on a weekend when his isnt working.
Which. is the first line treatment for chronic asthma?
Salbutamol or a short acting beta 2 antagonist
25 year old male works in a bakery, he suffers from hayfever and a family history of atopy. He presents with wheeze, cough that mainly comes on a t night, sputum and sometimes difficulty breathing. He is diagnosed with asthma.
Patient find his symptoms decrease on a weekend when his isnt working.
In the case of an acute severe asthma attack, state 1 way you could asses the severity of the attack?
Peak expiratory flow Ability to speak Respiratory rate Pulse rate O2 stats
